乙肝病毒高载量孕妇抗病毒治疗效果及母婴阻断效果分析

Analyses of the antiviral treatment efficacy in pregnant women with high HBV-DNA load and the mother-infant blocking efficacy

目的调查了解佛山地区乙肝病毒高载量孕妇的抗病毒治疗及母婴阻断效果,为本地区乙肝防控提供依据。方法选取2018年7月至2020年6月佛山市高明区人民医院妇产科183名乙肝病毒高载量孕妇和其新生儿作为研究对象。将规范产检和抗病毒治疗的乙肝病毒高载量孕妇141例作为治疗组,未规范产检和治疗来院分娩的乙肝病毒高载量孕妇42例作为未治疗组,另选同期乙肝病毒低载量孕妇83例作为对照组,三组孕妇所产新生儿共266例均接受规范的联合免疫阻断,分析孕妇抗病毒疗效及乙肝母婴阻断效果。结果治疗组血清谷丙转氨酶(ALT)和HBV-DNA载量较治疗前均降低,差异有统计学意义(P<0.05);三组孕期孕妇不良反应均为轻度,且三组不良反应发生率比较差异无统计学意义(P>0.05);三组产后出血、产褥期感染、早产、剖宫产、Apgar<10分发生率比较,差异无统计学意义(P>0.05)。治疗组和对照组血清学和分子生物学乙肝母婴阻断率均高于未治疗组,差异有统计学意义(P<0.05),治疗组与对照组比较,差异无统计学意义(P>0.05),266例新生儿仅检出1例隐匿性感染。Spearman秩相关分析结果显示,母体乙肝病毒感染模式与阻断效果呈正相关(r=0.682,P<0.05),母体乙肝病毒载量与阻断率呈负相关(r=-0.591,P<0.05)。结论对乙肝病毒高载量孕妇进行规范的产前检查和抗病毒治疗,安全有效,值得推广;本地区隐匿性感染流行较低;社区应加强流动人群乙肝阳性孕妇的产前管理。

Objective To investigate and understand the antiviral treatment efficacy in pregnant women with high hepatitis B virus(HBV)-DNA load and the mother-infant blocking efficacy in Foshan area,so as to provide evidence for prevention and control of HBV in this area.Methods A total of 183 pregnant women with high HBV-DNA load and their neonates admitted to the Department of Gynecology and Obstetrics of the Foshan Gaoming District People’s Hospital from July 2018 to June 2020 were selected as research subjects.Pregnant women with high HBV-DNA load who received standardized antenatal examination and antiviral treatment were included in the treatment group(n=141),and pregnant women with high HBV-DNA load who didn’t receive standardized antenatal examination and treatment and delivered in our hospital were included in the untreated group(n=42).In addition,pregnant women with low HBV-DNA load in the same period were included in the control group(n=83).A total of 266 neonates delivered by the three groups of pregnant women were all treated with standardized combined immune blockade,and the antiviral efficacy in pregnant women and the motherinfant blocking efficacy for HBV were analyzed.Results Serum ALT and HBV-DNA load in the treatment group were significantly lower than those before treatment(P<0.05).The adverse reactions of pregnant women in the three groups were mild,and there was no significant difference in the incidence of adverse reactions among the three groups(P>0.05).There was no significant difference in the incidence of postpartum hemorrhage,puerperal infection,premature delivery,cesarean section and Apgar<10 points among the three groups(P>0.05).The serological and molecular biological blocking rates of HBV in the treatment group and the control group were higher than those in the untreated group(P<0.05).There was no significant difference between the treatment group and the control group(P>0.05).Only one occult infection was detected in 266 newborns.Spearman rank correlation analysis showed that the maternal HBV infection pattern was positively correlated with the blocking effect(r=0.682,P<0.05),and the maternal HBV-DNA load was negatively correlated with the blocking rate(r=-0.591,P<0.05).Conclusion It is safe and effective to carry out standardized prenatal examination and antiviral treatment for pregnant women with high HBV-DNA load,which is worthy of promotion.The prevalence of occult infection is low in this area.The community should strengthen the prenatal management of HBV-positive pregnant women in floating population.